PDCA循环管理在Ⅰ类切口手术围术期抗菌药物预防的应用效果

The Effect of PDCA Circulation Management in the Prevention of Antibacterial DrugsDuring the Perioperative Period of Type Ⅰ Incision Surgery

目的探讨PDCA循环管理在Ⅰ类切口手术围术期抗菌药物预防的应用效果。方法回顾性分析2018年1~12月费县人民医院HIS系统调取Ⅰ类切口出院病历,将2018年1~4月未实施PDCA循环管理干预的1122例Ⅰ类切口出院病历作为干预前组,将2018年5~8月实施第1轮PDCA循环管理干预的1212例Ⅰ类切口出院病历作为第1轮干预组,另将2018年9~12月实施第2轮PDCA循环管理干预的932例Ⅰ类切口出院病历作为第2轮干预组,比较三组预防性抗菌药物应用情况、预防性抗菌药物品种选择情况、预防性抗菌药物时机选择及用药疗程情况。结果三组预防性抗菌药物使用率比较,差异无统计学意义(P>0.05);第2轮干预组预防用抗菌药物点评合理率高于第1轮干预组和干预前组,第1轮干预组高于预防用抗菌药物点评合理率干预前组(P<0.05)。第1轮干预组中头孢唑林、头孢呋辛和克林霉素的选择高于干预前组,而头孢硫脒、头孢曲松、阿莫西林克拉维酸、哌拉西林他唑巴坦、哌拉西林舒巴坦、美洛西林舒巴坦和拉氧头孢的选择占比低于干预前组(P<0.05);第2轮干预组中头孢呋辛和克林霉素的选择高于第1轮干预组,头孢唑林、头孢曲松、阿莫西林克拉维酸、哌拉西林他唑巴坦和美洛西林舒巴坦的选择占比低于第1轮干预组(P<0.05)。第2轮干预组时机选择合理率、疗程<24 h占比高于第1轮干预组及干预前组,且第1轮干预组高于干预前组(P<0.05);第2轮干预组疗程短于第1轮干预组及干预前组,第1轮干预组短于干预前组(P<0.05)。结论PDCA循环管理法提高了我院Ⅰ类切口手术围术期抗菌药物预防应用的合理性,但抗菌药物品种选择和时机选择的合理性以及预防用抗菌药物疗程还需要持续干预。

Objective To explore the effect of PDCA circulation management in the perioperative prevention of antibacterial drugs in Type I incision surgery.Methods A retrospective analysis of the HIS system of Feixian People's Hospital from January to December 2018 was used to collect the medical records of Type I incision discharge,and 1122 cases of Type I incision discharge medical records who did not implement PDCA cycle management intervention from January to April 2018 were used as the pre-intervention group.The medical records of 1212 patients with Type I incision discharge who implemented the first round of PDCA cyclic management intervention from May to August 2018 were used as the first round of intervention group,In addition,the medical records of 932 patients with type I incisions who were discharged from the second round of PDCA cycle management intervention from September to December 2018 were used as the second round of intervention group to compare the application of preventive antibiotics,the selection of preventive antibiotics,and prevention in the three groups the timing of sex antibacterial drugs and the course of medication.Results There was no statistically significant difference in the use rate of preventive antibiotics among the three groups(P>0.05);The reasonable evaluation rate of preventive antimicrobials in the second round of intervention group was higher than that of the first and pre-intervention groups,and the first round intervention group was higher than the reasonable rate of preventive antimicrobials in the pre-intervention group(P<0.05).The choices of ceftazolin,cefuroxime and clindamycin in the first round of intervention group were higher than those of the pre-intervention group,while cefathiamidine,ceftriaxone,amoxicillin,clavulanic acid,piperacillin,tazobactam,the proportions of piperacillin,sulbactam,mezlocillin,sulbactam,and laoxycephalosporin were lower than those of the pre-intervention group(P<0.05);The choice of cefuroxime and clindamycin in the second round of intervention group was higher than that of the first round of intervention group,cefazolin,ceftriaxone,amoxicillin and clavulanic acid,piperacillin,tazobactam and mezlocillin the proportion of batan selection was lower than that of the first round intervention group(P<0.05).The reasonable rate of timing selection and the proportion of treatment course of<24 h in the second round of intervention group were higher than that of the first round of intervention group and the pre-intervention group,and the reasonable rate of timing of the first round of intervention group was higher than that of the pre-intervention group(P<0.05);The treatment course of the second round of intervention group was shorter than that of the first round of intervention group and the pre-intervention group,and the treatment course of the first round of intervention group was shorter than that of the pre-intervention group(P<0.05).Conclusion The PDCA cycle management method improved the rationality of the perioperative use of antibacterial drugs for TypeⅠincision surgery in our hospital,but the rationality of the selection and timing of antibacterial drugs and the course of preventive antibacterial drugs needed continuous intervention.